The impact of preoperative hepatic hydrothorax on the outcome of adult liver transplantation

Sersté, Thomas; Moreno, Christophe; Francoz, Claire; Razek, Walid Abdel; Paugham, Catherine; Belghitti, Jacques; Valla, Dominique; Moreau, Richard; Durand, François

doi:10.1097/meg.0b013e3283311140

Cited by 38 publications

(32 citation statements)

References 25 publications

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“…Similar findings were also observed in another study that compared pre- and posttransplant symptoms and management of patients with HH and end-stage liver disease [74]. Of 11 patients, 73% needed thoracentesis in the pretransplant course, with 55% requiring more than once.…”

Section: Managementsupporting

confidence: 72%

Evidence-Based Review of the Management of Hepatic Hydrothorax

Singh¹,

Bajwa²,

Shujaat³

2013

Respiration

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Hepatic hydrothorax (HH) is an example of a porous diaphragm syndrome. Portal hypertension results in the formation of ascitic fluid which moves across defects in the diaphragm and accumulates in the pleural space. Consequently, the treatment approach to HH consists of measures to reduce the formation of ascitic fluid, prevent the movement of ascitic fluid across the diaphragm, and drain or obliterate the pleural space. Approximately 21-26% of cases of HH are refractory to salt and fluid restriction and diuretics and warrant consideration of additional treatment measures. Ideally, liver transplantation is the best treatment option; however, most of the patients are not candidates and most of those who are eligible die while waiting for a transplant. Treatment measures other than liver transplantation may not only provide relief from dyspnea but also improve patient survival and serve as a bridge to liver transplantation.

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Section: Managementsupporting

confidence: 72%

Evidence-Based Review of the Management of Hepatic Hydrothorax

Singh¹,

Bajwa²,

Shujaat³

2013

Respiration

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“…These results have been confirmed by others. 60 In conclusion, liver transplantation is the best therapy for patients with HH; there are not more complications related to pleural effusion, and long-term survival is similar to that for patients without hydrothorax. A treatment algorithm for refractory hepatic hydrothorax in shown in Fig.…”

Section: Diagnosismentioning

confidence: 78%

Pleural Effusion in Liver Disease

Alonso

2010

Semin Respir Crit Care Med

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Hepatic hydrothorax is the paradigmatic pleural effusion in liver cirrhosis. It is defined as a pleural effusion in a patient with portal hypertension and no cardiopulmonary disease. The estimated prevalence of this complication in patients with liver cirrhosis is 5 to 6%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. Thoracentesis and pleural fluid analysis are necessary for diagnosis. Initial management consists of sodium restriction, diuretics, and therapeutic thoracentesis. A transjugular intrahepatic portosystemic shunt may provide a bridge prior to liver transplantation. Spontaneous bacterial empyema is the infection of a preexisting hydrothorax. The more frequent bacteria involved are ENTEROBACTERIACEAE and gram-positive cocci. Antibiotic therapy is the cornerstone of therapy. This article reviews etiology, clinical manifestations, and therapy of these two complications of liver cirrhosis and portal hypertension.

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“…However, the mean oxygen indices of the patients with PMV remained within the normal range, and none of the pulmonary variables were identified as independent risk factors in the predictive model for PMV. These results suggest that, similar to recipients of LT for other conditions, pulmonary complications do not play a significant role in the outcome of PMV in patients with ALF [30]. …”

Section: Discussionmentioning

confidence: 92%

Perioperative risk factors for prolonged mechanical ventilation after liver transplantation due to acute liver failure

Lee

Jung

Choi

et al. 2013

Korean J Anesthesiol

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BackgroundAcute liver failure (ALF) is a rapidly progressing and fatal disease for which liver transplantation (LT) is the only treatment. Posttransplant mechanical ventilation tends to be more prolonged in patients with ALF than in other LT patients. The present study examined the clinical effects of prolonged posttransplant mechanical ventilation (PMV), and identified risk factors for PMV following LT for ALF.MethodsWe reviewed data of patients undergoing LT for ALF between January 2005 and June 2011. After grouping patients according to administration of PMV (≥ 24 h), donor and recipient perioperative variables were compared between the groups with and without PMV. Potentially significant factors (P < 0.1) from the univariate intergroup comparison were entered into a multivariate logistic regression to establish a predictive model for PMV.ResultsTwenty-four (25.3%) of 95 patients with ALF who received PMV had a higher mortality rate (29.2% vs 11.3%, P = 0.038) and longer intensive care unit stay (12.9 ± 10.4 vs 7.1 ± 2.7 days, P = 0.012) than patients without PMV. The intergroup comparisons revealed worse preoperative hepatic conditions, more supportive therapy, and more intraoperative fluctuations in vital signs and less urine output in the with- compared with the without-PMV group. The multivariate analysis revealed that preoperative hepatic encephalopathy (≥ grade III), intraoperative blood pressure fluctuation, and oliguria (< 0.5 ml/kg/h) were independent risk factors for PMV.ConclusionsPMV was associated with deleterious outcomes. Besides care for known risk factors including hepatic encephalopathy, meticulous attention to managing intraoperative hemodynamic circulatory status is required to avoid PMV and improve the posttransplant prognosis in ALF patients.

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The impact of preoperative hepatic hydrothorax on the outcome of adult liver transplantation

Cited by 38 publications

References 25 publications

Evidence-Based Review of the Management of Hepatic Hydrothorax

Evidence-Based Review of the Management of Hepatic Hydrothorax

Pleural Effusion in Liver Disease

Perioperative risk factors for prolonged mechanical ventilation after liver transplantation due to acute liver failure

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